Smaller hamstrings autograft size after primary ACL reconstruction is associated with higher odds for graft failure: A meta-analysis on autografts sizes covering 46,268 patients.
Rebecca Hamrin Senorski, Johan Högberg, Kevin Teow et al.
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In 30 seconds
This meta-analysis examined whether autograft size was associated with graft failure after primary anterior cruciate ligament reconstruction. It included 35 studies covering 46,268 patients, predominantly with hamstring tendon (HT) autografts. Compared with larger grafts, HT grafts below 7, 8, and 9 mm were associated with 81%, 46%, and 34% greater odds of failure, respectively. No significant association was found for patellar tendon graft size; quadriceps tendon evidence was too limited to pool. The findings indicate an association, not proof that graft size itself causes failure.
Key findings
- HT autografts <7 mm had 81% greater odds of graft failure than those ≥7 mm (p=0.01).
- HT autografts <8 mm had 46% greater odds of failure than those ≥8 mm (p<0.0001).
- HT autografts <9 mm had 34% greater odds of failure than those ≥9 mm (p=0.001).
- No significant association was observed for patellar tendon graft size; quadriceps tendon data could not be pooled.
Why it matters
Graft failure is an important outcome after ACL reconstruction, and this synthesis suggests that smaller hamstring tendon grafts are associated with higher failure odds across several size thresholds. The results may help inform consideration of graft dimensions during reconstruction, while the lack of a demonstrated association for patellar tendon grafts and limited quadriceps tendon evidence underscore that findings differ by graft type.
What to keep in mind
The meta-analysis included observational studies, so the associations do not establish causation. Quadriceps tendon evidence was limited to two studies and could not be pooled.